{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:15:43Z","timestamp":1790882143233,"version":"4.1.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Key Project of National Social Science Foundation of China","award":["23ASH013"],"award-info":[{"award-number":["23ASH013"]}]},{"name":"Guangdong Basic and Applied Basic Research Foundation \u2013 Natural Science Foundation Project","award":["2023A1515010778"],"award-info":[{"award-number":["2023A1515010778"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Depression among older adults is a growing concern globally, influenced by both environmental stressors and individual health conditions. This study examines the impact of heatwave exposure and multimorbidity on depressive symptom trajectories among older Chinese adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from 3819 adults aged 60 and older across 5 waves of the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Latent growth curve modeling identified depressive trajectories, and machine learning algorithms (Random Forest, Decision Tree, XGBoost, and Support Vector Machine) were applied to predict trajectory categories. Multinomial logistic regression further explored the moderating effects of multimorbidity on the heatwave-depression relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five distinct depressive symptom trajectories were identified: consistently high, high but decreasing, consistently low, high and increasing, and low but increasing. Heatwave exposure was associated with a higher likelihood of persistent or worsening depressive symptoms, particularly among individuals with multimorbidity. Machine learning analysis highlighted maximum temperature as one of the most influential predictors, and further demonstrated that multimorbidity amplified the effect of heatwave exposure on depression trajectories. Multinomial logistic regression confirmed that individuals with multimorbidity were significantly more likely to exhibit worsening depressive symptoms when exposed to elevated temperatures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the vulnerability of older adults with multimorbidity to worsened depression under heatwave exposure, emphasizing the need for tailored mental health interventions. Integrating climate adaptation and multimorbidity care is crucial for mitigating mental health impacts in this population. Policymakers should prioritize targeted interventions, incorporating climate adaptation and heatwave preparedness into mental health protocols to reduce adverse outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/gerona\/glaf209","type":"journal-article","created":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T11:47:33Z","timestamp":1759060053000},"source":"Crossref","is-referenced-by-count":4,"title":["Association of heatwave exposure and multimorbidity with depression trajectories among older adults: evidence from the China Health and Retirement Longitudinal Study"],"prefix":"10.1093","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7907-5715","authenticated-orcid":false,"given":"Boye","family":"Fang","sequence":"first","affiliation":[{"name":"School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou ,","place":["China"]},{"name":"School of Medicine, Sun Yat-sen University, Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3473-7166","authenticated-orcid":false,"given":"Youwei","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xubao","family":"Li","sequence":"additional","affiliation":[{"name":"School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanbi","family":"Hong","sequence":"additional","affiliation":[{"name":"School of Humanities, Southeast University , Nanjing, Jiangsu,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"key":"2026072004513202600_glaf209-B1","volume-title":"Working for a Brighter, Healthier Future: How WHO Improves Health and Promotes Well-Being for the World\u2019s Adolescents","author":"WHO","year":"2024"},{"key":"2026072004513202600_glaf209-B2","first-page":"1204","volume-title":"Lancet","author":"Vos","year":"2020"},{"key":"2026072004513202600_glaf209-B3","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1176\/appi.focus.20210006","article-title":"Late life depression: the essentials and the essential distinctions","volume":"19","author":"Husain-Krautter","year":"2021","journal-title":"Focus."},{"key":"2026072004513202600_glaf209-B4","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1146\/annurev-publhealth-040218-044106","article-title":"Environmental exposures and depression: biological mechanisms and epidemiological evidence","volume":"40","author":"van den Bosch","year":"2019","journal-title":"Annual Rev Pub Health."},{"key":"2026072004513202600_glaf209-B5","doi-asserted-by":"publisher","first-page":"3229","DOI":"10.3390\/ijerph20043229","article-title":"Long-term apparent temperature, extreme temperature exposure, and depressive symptoms: a longitudinal study in China","volume":"20","author":"Jin","year":"2023","journal-title":"Int J Environ Res Public Health."},{"key":"2026072004513202600_glaf209-B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.lanepe.2022.100391","article-title":"Predictors of depression among middle-aged and older men and women in Europe: a machine learning approach","volume":"18","author":"Handing","year":"2022","journal-title":"Lancet Reg Health Eur."},{"key":"2026072004513202600_glaf209-B7","doi-asserted-by":"publisher","first-page":"106170","DOI":"10.1016\/j.envint.2020.106170","article-title":"Association between ambient temperature and heat waves with mortality in South Asia: systematic review and meta-analysis","volume":"146","author":"Dimitrova","year":"2021","journal-title":"Environ Int."},{"key":"2026072004513202600_glaf209-B8","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1007\/s11069-023-06070-2","article-title":"Climate change effects on vulnerable populations in the Global South: a systematic review","volume":"118","author":"Ngcamu","year":"2023","journal-title":"Nat Hazards"},{"key":"2026072004513202600_glaf209-B9","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1017\/S1092852920001303","article-title":"Environmental pollution and mental health: a narrative review of literature","volume":"26","author":"Ventriglio","year":"2021","journal-title":"CNS Spectr."},{"key":"2026072004513202600_glaf209-B10","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1177\/002214650504600206","article-title":"Stress, health, and the life course: some conceptual perspectives","volume":"46","author":"Pearlin","year":"2005","journal-title":"J Health Soc Behav"},{"key":"2026072004513202600_glaf209-B11","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s10802-008-9228-6","article-title":"Cognitive vulnerability\u2013stress model of depression during adolescence: investigating depressive symptom specificity in a multi-wave prospective study","volume":"36","author":"Hankin","year":"2008","journal-title":"J Abnorm Child Psychol."},{"key":"2026072004513202600_glaf209-B12","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.1038\/s41591-023-02420-6","article-title":"Biological and functional multimorbidity\u2014from mechanisms to management","volume":"29","author":"Langenberg","year":"2023","journal-title":"Nat Med."},{"key":"2026072004513202600_glaf209-B13","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jpsychires.2021.04.003","article-title":"A systematic review of the association between biological markers and environmental stress risk factors for adolescent depression","volume":"138","author":"Zajkowska","year":"2021","journal-title":"J Psychiatr Res."},{"key":"2026072004513202600_glaf209-B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1029\/2012GL053361","article-title":"Increasing frequency, intensity and duration of observed global heatwaves and warm spells","volume":"39","author":"Perkins","year":"2012","journal-title":"Geophys Res Lett"},{"key":"2026072004513202600_glaf209-B15","doi-asserted-by":"publisher","first-page":"S85","DOI":"10.1097\/01.ede.0000339795.05175.c2","article-title":"The effect of heatwaves on mental health in a temperate Australian city","volume":"19","author":"Hansen","year":"2008","journal-title":"Epidemiology"},{"key":"2026072004513202600_glaf209-B16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.eclinm.2023.101860","article-title":"Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis","volume":"57","author":"Chowdhury","year":"2023","journal-title":"EClinicalMedicine."},{"key":"2026072004513202600_glaf209-B17","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1186\/s12877-023-04128-1","article-title":"Sociodemographic and lifestyle determinants of multimorbidity among community-dwelling older adults: findings from 346,760 SHARE participants","volume":"23","author":"Ni","year":"2023","journal-title":"BMC Geriatr."},{"key":"2026072004513202600_glaf209-B18","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1093\/gerona\/glz137","article-title":"Patterns of multimorbidity in a population-based cohort of older people: sociodemographic, lifestyle, clinical, and functional differences","volume":"75","author":"Marengoni","year":"2020","journal-title":"J Gerontol A Biol Sci Med Sci."},{"key":"2026072004513202600_glaf209-B19","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1001\/jamapsychiatry.2013.193","article-title":"The trajectory of depressive symptoms across the adult life span","volume":"70","author":"Sutin","year":"2013","journal-title":"JAMA Psychiatry."},{"key":"2026072004513202600_glaf209-B20","doi-asserted-by":"publisher","first-page":"1999","DOI":"10.1002\/qj.3803","article-title":"The ERA5 global reanalysis","volume":"146","author":"Hersbach","year":"2020","journal-title":"Q J R Meteorol Soc"},{"key":"2026072004513202600_glaf209-B21","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1046\/j.1399-5618.2003.00081.x","article-title":"Admission rates of bipolar depressed patients increase during spring\/summer and correlate with maximal environmental temperature","volume":"6","author":"Shapira","year":"2004","journal-title":"Bipolar Disord."},{"key":"2026072004513202600_glaf209-B22","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s00127-012-0542-5","article-title":"A positive relationship between ambient temperature and bipolar disorder identified using a national cohort of psychiatric inpatients","volume":"48","author":"Sung","year":"2013","journal-title":"Soc Psychiatry Psychiatr Epidemiol."},{"key":"2026072004513202600_glaf209-B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0164190","article-title":"The importance of humidity in the relationship between heat and population mental health: evidence from Australia","volume":"11","author":"Ding","year":"2016","journal-title":"PloS one"},{"key":"2026072004513202600_glaf209-B24","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1176\/appi.ps.201100485","article-title":"Relationship between ambient temperature and humidity and visits to mental health emergency departments in Qu\u00e9bec","volume":"63","author":"Vida","year":"2012","journal-title":"Psychiatr Serv"},{"key":"2026072004513202600_glaf209-B25","doi-asserted-by":"publisher","first-page":"3149","DOI":"10.1038\/s41380-023-02095-y","article-title":"A leaky umbrella has little value: evidence clearly indicates the serotonin system is implicated in depression","volume":"28","author":"Jauhar","year":"2023","journal-title":"Mol Psychiatry."},{"key":"2026072004513202600_glaf209-B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.yfrne.2019.04.003","article-title":"Circadian regulation of depression: a role for serotonin","volume":"54","author":"Daut","year":"2019","journal-title":"Front Neuroendocrinol."},{"key":"2026072004513202600_glaf209-B27","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1503\/cmaj.081050","article-title":"Heat stress in older individuals and patients with common chronic diseases","volume":"10","author":"Kenny","year":"2010","journal-title":"Cmaj."},{"key":"2026072004513202600_glaf209-B28","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1289\/ehp.0900612","article-title":"A framework for examining social stress and susceptibility to air pollution in respiratory health","volume":"117","author":"Clougherty","year":"2009","journal-title":"Environ Health Perspect."}],"container-title":["The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/advance-article-pdf\/doi\/10.1093\/gerona\/glaf209\/64434781\/glaf209.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/article-pdf\/80\/12\/glaf209\/64434781\/glaf209.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/article-pdf\/80\/12\/glaf209\/64434781\/glaf209.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:51:42Z","timestamp":1784537502000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/biomedgerontology\/article\/doi\/10.1093\/gerona\/glaf209\/8268539"}},"subtitle":[],"editor":[{"given":"Lewis A","family":"Lipsitz","sequence":"additional","affiliation":[{"name":"(Medical Sciences Section)"}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":28,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,11,6]]}},"URL":"https:\/\/doi.org\/10.1093\/gerona\/glaf209","relation":{},"ISSN":["1079-5006","1758-535X"],"issn-type":[{"value":"1079-5006","type":"print"},{"value":"1758-535X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,9,30]]},"article-number":"glaf209"}}